血浆置换联合连续性血液净化技术治疗急性毒蕈中毒患者多脏器功能衰竭的临床观察

Therapeutic effect observation of the protection on MODS of acute wild mushroom poisoning patients by continuous blood purification combined with plasma exchange in the treatment of severe hepatopathy

目的观察应用血浆置换（PE）联合连续性血液净化（CBP）对急性毒蕈中毒患者多器官功能障碍综合征（MODS）的临床疗效。方法将81例伴有急性肝功能衰竭毒蕈中毒的MODS患者采用随机双盲的分组方式分为治疗组（PE、CBP联合解毒药物）和对照组（单用PE联合解毒药物），14d为一疗程。监测入院时、入院后、CBP结束后、入院第14天血浆TBIL、ALT、Cr、BUN、IL-6、IL—10、TNF-α、芳香氨基酸、内毒素等水平。结果治疗组给予联合CBP治疗后血浆肝功能指标、肾功能指标均明显降低（P〈0．05），血清蛋白结合毒素及血清细胞因子指标均明显降低（P〈0．01），SIRS评分及APACHEⅡ评分均明显降低（P〈0．05）。结论联合CBP技术能够清除急性毒蕈中毒合并MODS患者的炎性介质，改善肝肾功能及预后。

Objective To observe the clinical effect of the protection on multiple organ dysfunction syndrome （MODS） of acute wild mushroom poisoning patients by using continuous blood purification （CBP） combined with plasma exchange （PE）. Methods A total of 81 acute wild mushroom poisoning patients were randomly divided into two groups, 41 in the combination treatment group treated by CBP combined with PE and antidote, 40 in the control group treated by PE and antidote. After a 14-day treatment, the patients were observed the following indicators, TBIL, ALT, Cr, BUN, IL-6, IL-10, TNF- α and etc. Results CBP combined with PE treatment group showed a significant improvement than the control group in means of TBIL, ALT, Cr, BUN, IL-6, IL-10, TNF-α and etc （P〈0.01）. SIRS and APACHE Ⅱ score were significantly decreased in first group （P 〈 0.05）. Conclusion CBP combined with PE treatment plays a protecting role in acute wild mushroom poisoning patients, because it helps to clean up inflammatory substances and improve the function of liver and kidney.